20191365 Ver 1_Shoreline Stabilization_20191007

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State of?N*rth Carolina
Department of Environment and Ni6kal to , ces
Division of Water Regrf rc�51:..
DWR
y
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabila8tlon
Division of Water Resources FORM' SSGP 10 -2011 -
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fee should be sent
to:
Division of Water Resources 2 Q
401 & Buffer Permitting Unit j
1617 Mail Service Center 6 5
Raleigh, NC 27699-1617
I. Applicant Information [15A NCAC 02H .0502(a)1
1. Owner Information
Name: Greta Sherwood REC�iVGll)EldR/l?1NR
Mailing Address: 20516 Deep Cove Ct VST U-7
Cornelius, NC 28031
Water Resources
T�IIIII I\tll� VGa MINI
Telephone Number: 7049066719 Fax Number:
E-mail Address: [e-mail]
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
http //www saw usace army mil/Portals/59/docs/reizulatory/rejzdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name: Dean Fisher
Company Affiliation: President Lake Norman Custom Dock & Pile Driving, Inc.
Mailing Address: PO Box 1439
Denver NC 28037
Telephone Number: 7044832144 Fax Number:
E-mail Address: [e-mail]
Person to receive the Certification Approval: Dean Fisher and Greta Sherwood
II. Project Information [15A NCAC 02H .0502(a) & (b)l
1. Attach a vicinity map (i.e. street map) clearly showing the location of the property with
respect to local landmarks such as towns, rivers, and roads.
2. Provide a detailed site plan showing property boundaries and proposed locations of
vegetation clearing, structures (buildings, retaining walls, docks, impervious surfaces,
FORM: SSGP 10-2013
Page 1 of 3

etc.), rip rap, excavation or dredging below Full Pond/ Normal Water Level elevations,
and construction access corridors. You may use the diagram provided at the end of this
application form.
3. Attach a photograph of the shoreline/ buffer proposed to be stabilized. (Include a scale
of some sort- a yard stick, shovel handle, etc.)
4. Location of the property (where work is to be conducted)
County: Mecklenburg Nearest Town: Cornelius
Subdivision name or site address (include phase/lot number): _
Deep Cove lot #8
Directions to site - please include road names and numbers, landmarks, etc.:
Take NC -73E towards Huntersville. Turn left onto W Catawba Ave.
Turn left onto Bethel Church Rd. Turn right onto Walter Henderson Rd.
Turn left onto Deep Cove Ct. Property is on the right.
Latitude (in decimoi degrees) 35.4903069 Longitude (decimal degrees) -80.8975441
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): residential
6. Property size (acres): 0.86
7. Lake/ river/ ocean adjacent to property: Norman
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): Existing wooden seawall is failing
9. Will work be conducted from land? ® From water? ❑
10. Total amount of disturbance (including all excavation, backfill, rip rap, retaining walls, etc.)
below the normal pool lake level/ Normal Water Level in square feet or acres:
300 Sa ft
11. Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining
walls, etc.) above the normal pool lake level/ Normal Water Level and 50 feet land -ward in
square feet or acres: 1,500 Sq ft
12. Please describe the vegetation above the normal pool lake level/ Normal Water Level and
50 feet landward to be impacted (number of trees, for instance):
Landscaped areas with shrubbery and grass
9- C,
Owner/Agent's Signature' [15A NCAC 02H .0502(f)l Date
*Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

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10/2/2019
Shoreline - Google Maps
Gogle Baps Shoreline
vicinity map 20516 Deep Cove Ct, Cornelius NC 28031
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SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. 8
PLAN NO.
PARCEL ID: 00149182
STREET ADDRESS: 20516 DEEP COVE CT CORNELIUS NC 28031
Please print:
Property Owner
Property Owner:
Greta Sherwood
The undersigned, registered property owners of the above noted property, do hereby authorize
Dean Fisher _
(Contractor / Agent)
of Lake Norman Custom Dock & Pile Driving, Inc
(Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above):
Telephone:
7049066719
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
J11— -- — ---
Authorized Signature Authorized Signature
Date: --_ I — 219- _1 Cl --- Date:

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